Provider Demographics
NPI:1124452008
Name:NICHOLS, LACEY A (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:A
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 DRY HOLLOW RD STE 4 1/2
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3167
Mailing Address - Country:US
Mailing Address - Phone:541-240-8938
Mailing Address - Fax:
Practice Address - Street 1:1210 DRY HOLLOW RD STE 4 1/2
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3167
Practice Address - Country:US
Practice Address - Phone:541-240-8938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL114571041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical